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rne Euagreen <br />cm oF <br />everett <br />259-8745 <br />� C�'NSTRUCTION � � = � 2101 ] <br />PERMIT � PERMITN(�= . . <br />❑ DEMOLITION ❑ COMBINATION Q BUILDING ly� MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEF MAIIADDRE55 CITY ZIP PHONE <br />Mr. Arl.and Rose 13526 � Hwy 99 Everett 96204 742-3322 <br />ApCIJTECIOqOESIGNEf: MFILAODRESS CITY ZIV PHONE <br />GENER�L CONTRALTOR MPIL NDDRESS CITY 21P PHONE LICELSE t <br />I,IEGHANIGALGONTFACTOR MAILNDDRESS CITY 21P PMONE LICENSE� <br />Ken's Refrigeration 19007 80th NE Bothell 98011 778-3941 KENSRS*158JK <br />PLUMBINGGONTFACTOR MAILADDRE55 CITY 21P FNONE LICENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />VA�UATION OF WOFK <br />i <br />OESCRIBE WORK <br />Install heat p�� <br />❑ ALTERATfON ❑ REPAIR <br />HEATSOURGE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE <br />Conv. Store/gas � station <br />LOT __ BLOLN _._ <br />333 IX SW Everett Mall <br />PLUMBING <br />NO. TYPE OF FIXTI <br />WATER CLOSET (701LET) <br />BATHTUB <br />LAVATORY (WASH BASIN; <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNOflVTRAV <br />CLOTHES WASHER <br />FOUNTAIN <br />FLOOR <br />FOOF DRAINS - RAINI <br />SIN� (SEflVICE - BAR. <br />TYPE OF CONST <br />SIZE OF BLOG. <br />FPPLICATION ACC. BY <br />S.H. <br />❑ OEMOLITION <br />❑ OTHER <br />❑ BUILDING RELOCATION <br />I HEREBY CERTIf-Y THAT I HAVE REnD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. HLL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR L CAL lAW REGULATING CONSTRUCTION OR <br />THE PE FO A E OF COIJSTRUCTION. <br />SIGNAT OFC iHACT R AUTHOR12EDAGENT.OflOWNEii ORTE <br />X T1.A�O.0 � 1 0—//— �6"�. <br />MECHANICAL <br />FEE NO. TYPE OF EQUIPMENT <br />A/C — A/HNOLG UNITS — H.P. <br />REFHIGERATION UNITS — H.P. EA. <br />BOILERS — B.T.U./H.P. <br />GAS FIRED A�C. UNITS — B.T.U. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WALL HEATEPS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERIfEATEF • <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSERT <br />1 HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTIIL f <br />PERMI7 f <br />TO7AL FEE S <br />PEAR SETBPCN SIpE SETBACN <br />LOTAREA yqCANTSITE <br />❑YES ❑NO <br />OCCUPANCYGROUP NO.OFOWELUNGUNITS <br />NO.OF STORIES MA%.00Q LOA� <br />1 ❑ YES � NO <br />PLANS CH[CRCD BY � APPfl. FOH ISSUANCE 0Y <br />PLAN CHECK NUMBER FFF_CF; S A`r�IPT NO. <br />Ghlt '�. W <br />FEES VALUATION FE <br />BUILOING $ <br />PLUMBMG <br />MECHANICAL <br />INVESi�IGATION FEE Sec.304(e) <br />STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />�RIVEWAY PERMIT <br />TOTAL <br />PEflMIT VALIDATION <br />WHEN PROPERLV VALIDATED (IN THIS SPACE) THIS IS VOUH PERMIT <br />A�URESS FILE <br />� <br />t� <br />� <br />r <br />N <br />